Public/Global Health

Expats plead with US to deliver COVID-19 vaccines

Frustration is growing among Americans abroad as many have yet to receive a Food and Drug Administration (FDA) approved coronavirus vaccine at a time when the delta variant is wreaking havoc worldwide.

Lawmakers on both sides of the aisle have called on the Biden administration to make doses available to expatriates as part of the U.S. government's global vaccination efforts.

But the administration has yet to address the issue beyond saying the State Department does not typically provide direct medical care to private citizens abroad.

U.S. citizens overseas, who remain subject to federal tax laws, are pleading for access to the vaccine, particularly in countries that don't have enough supply or that only offer non-FDA-authorized doses. Some reside in countries that prioritize their own citizens over foreign residents, putting Americans near the back of the line.

"Unless the U.S. government comes up with a plan to help those people directly, it could be a long time," a Democratic aide told The Hill. "Waiting is not a viable option in some of those places."

Megan Slattery, a 19-year-old American living in Indonesia, said it has been an "exhausting" process to find a coronavirus vaccine, involving "hours of research" and rejections from vaccination sites because of her documents or her status as a foreign resident.

"I've felt helpless knowing that I've gone through all the work of trying to find any place that would vaccinate me," she said.

She's also been unable to secure a booster for her 83-year-old father, a veteran who received the Chinese Sinovac vaccine earlier this year, making it "almost impossible" to get a different, potentially more effective shot.

"Ultimately, I am more worried for him than I am for myself," Slattery said. "So yes, I feel this pressure and dread, and I'm still in this constant state of anxiety when it comes to getting vaccines for the both of us."

Meanwhile, the Biden administration has focused much of its attention on the millions of unvaccinated people in the U.S., instituting requirements in the hopes of increasing the domestic vaccination rate.

"Everybody's screaming right now: 'Get vaccinated! Get vaccinated! Get vaccinated!' " said Tim Mow, who lives in Thailand. "What makes me any different than somebody living in California or Pennsylvania or New York or whatever?"

In recent letters to the administration, senators and House members have called for federal officials to provide expatriates with access to vaccines, instead of leaving Americans abroad to decide whether they can afford and risk a trip back to the U.S.

Mow, who is 54 and has lived abroad for 20 years, said he does not consider leaving his home on the island Phuket a viable option over "the fear" of not being able to return due to COVID-19 restrictions. He has been unable to receive a vaccine in Thailand due to conflicts with his visa.

Jennifer Westfall, a public health consultant also living in Southeast Asia, faced a deadline through her employer to get vaccinated and decided to fly 20 hours to the U.S. to get her shot amid the uncertainty of Thailand's rollout.

At least five Americans died in Thailand of COVID-19 last month.

The U.S. has committed to distribute more than 1.1 billion doses globally. As of late September, about 140 million doses had been delivered to at least 93 countries, with most of these doses being through the COVAX program for low- and middle-income countries, according to the Kaiser Family Foundation.

The U.S. government has not stipulated whether a certain number of donated doses need to go to Americans living abroad, although the Thai government voluntarily reserved 10 percent for foreign nationals, including Americans.

France has taken a different approach, with the French Embassy in Thailand opening up vaccinations for its citizens and their spouses by contracting with local, private hospitals.

"I think it's a win-win because your citizens will have access to safe, effective, locally approved vaccines," Westfall said. "They won't be flying home and potentially bringing new variants with them. It makes France safer. It makes the world safer."

Sens. Chris Murphy (D-N.J.) and Jerry Moran (R-Kan.), along with 24 other senators, wrote to Secretary of State Antony Blinken in June requesting priority for Americans living in countries not offering FDA-approved vaccines to U.S. citizens.

More recently, Rep. Raúl Grijalva (D-Ariz.) led a group of 27 representatives this month who encouraged Blinken and President Biden to take executive action to improve vaccine accessibility for Americans abroad, including "tens of thousands of veterans."

The State Department said in a statement to The Hill that while it has "no greater responsibility than the safety and security of U.S. citizens overseas," the agency "does not provide direct medical care to private U.S. citizens abroad."

Instead, a spokesperson said, the department collaborates with countries with "robust" vaccination programs to vaccinate Americans overseas and ensures other citizens can return to the U.S. to be vaccinated "easily and effectively."

Marylouise Serrato, executive director of American Citizens Abroad, said that even though the world is in "some real uncharted territory," it's an area "the administration, the State Department should focus on and should try to find a path forward."

U.S. citizens do not have to register that they are living abroad, so there are no comprehensive lists of Americans living overseas. But veterans are estimated to make up a sizable portion of the expat community. The group Military-Veterans Advocacy puts that number at about 20 percent.

Retired Navy Commander John Wells, the group's executive director, asked the Department of Veterans Affairs to enter into an agreement with the Defense and State departments to administer vaccines for veterans at military facilities and consulates abroad, citing the Save Lives Act, which requires the VA to vaccinate any veterans and their spouses who want the shot.

"We frankly don't give a damn on how they do it," Wells said.

"We need to stop talking about this and start acting," he added.

VA Secretary Denis McDonough responded in a letter last month that the department doesn't have the "legal authority to furnish Veterans and their families with COVID-19 vaccinations outside the United States."

Wells, who is also an attorney, said there's a "possibility" litigation against the department will be pursued, but his organization has not reached a final decision.

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